Raynaud phenomenon

Summary

Raynaud phenomenon (RP) is an exaggerated vasoconstrictive response of the digital arteries and arterioles (e.g., in the fingers and/or toes) to cold or emotional stress. It is termed primary or secondary based on the underlying cause. The etiology of primary RP is poorly understood. Secondary RP, on the other hand, is caused by underlying systemic diseases (e.g., mixed connective tissue disease, vasculitides, hematologic abnormalities). Both types typically present with the sequential discoloration of fingers and/or toes from white (ischemia) to purplish-blue (hypoxia) to red (reactive hyperemia). Episodes of vasoconstriction usually end 15–20 minutes after the trigger is removed, and last no longer than an hour following adequate warming or stress reduction. Secondary RP may be accompanied by complications of underlying diseases and/or trophic disorders. Management involves the treatment of any underlying conditions, avoidance of situations that may trigger an attack, and calcium channel blockers (e.g., nifedipine, diltiazem). Rubefacients, or vasoactive agents, are indicated in severe cases.

Etiology

Cold and emotional stress are common triggers of vasospastic attacks in patients with primary or secondary RP.

Primary RP (also called Raynaud disease)

Idiopathic genesis, without any identifiable organic vascular change, leading to vasospasms of the digital arteries and arterioles.

Secondary RP

Organic arterial changes in the fingers (and/or toes) that lead to vasospasm, which may be caused by:

Diagnostics

While primary RP is primarily a clinical diagnosis, additional testing is required to diagnose secondary RP; . Differentiating between the two types enables the practitioner to identify and assess the severity of any possible underlying condition.

Patient history

Assessment of patient history focuses on: onset of symptoms, triggers of attacks, time course, pattern of attacks, accompanying symptoms (pain, paresthesias), and impairment of everyday life.